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There are a few assumptions built into the question, “How do you deal with cerebral narcissists?” that need to be clarified.(1) There is no such thing as a cerebral narcissist.Mental health professionals do not use the term “cerebral narcissist.” That is a diagnosis made up by Sam Vaknin who has absolutely no standing in the fields of psychology or psychiatry.(2) Who is Sam Vaknin?Sam Vaknin is a man with no degrees in paychology, psychiatry, or any other mental health field. He has no formal training in the diagnosis and treatment of personality disorders. Vaknin was convicted of security fraud and sentenced to 18 months in prison. At that time he was given a mental health examination and found to have Narcissistic Personality Disorder. Vaknin agreed that the diagnosis fit him.In true grandiose Exhibitionist form, he declared himself an expert in the diagnosis and treatment of NPD. He started inventing what he considers to be highly original and extremely successful treatments for NPD. They are neither original nor particularly successful, despite his claims. His field is finance. He was imprisoned for securities fraud. Why would anyone trust him to diagnose personality disorders?(3) What is wrong with Vaknin’s concept of the cerebral narcissist?Vaknin divides people with NPD into two groups based on how they get their narcissistic supplies—Somatic narcissists who are focused on their looks and Cerebral narcissists who are focused on their minds and how smart they are.5 Problems with Vaknin’s work:People with NPD do not neatly divide into these two categories. Most people with NPD simply use whatever they can to feel superior to shore up their shaky self-esteem. Most sources of narcissistic supplies do not fit into either of these overly simplistic categories. For example, many Narcissists get their narcissistic supplies from bragging about the famous people they know, how much money they make, or devaluing other people.Vaknin never studied differential diagnosis, so he over diagnoses people as Narcissists. He did not sufficiently study Schizoid PD or Borderline PD. Some of the people he diagnoses as Cerebral Narcissists appear to actually have Schizoid PD based on his descriptions.Vaknin is just making things up. Because he does not appear to have immersed himself in the existing literature and research on personality disorders, he often invents some very simple method that has already been tried and rejected by other more expert clinicians.Vaknin is extremely grandiose, still appears to be highly narcissistic himself, and makes highly unlikely claims about his success rate. He is not a trained psychotherapist and he has a coach in some of his podcasts who is equally unqualified and not legally permitted to diagnose ANY mental disorder, let alone anything as complicated and serious as Narcissistic Personality Disorder.Vaknin’s division of people with NPD into Cerebral and Somatic Narcissists is completely irrelevant to the actual treatment of these groups. The purpose of diagnosis is to allow the psychotherapist to choose the best treatment. Whether people brag about their body or their brain does not have a significant impact on their treatment. It is pretty useless.(4) How do you deal with cerebral narcissists?I do not deal with Cerebral narcissists. I keep an open mind and I do a careful intake for each new client. Before I even think of Narcissism, I decide whether they actually qualify for a personality disorder diagnosis. Then I decide which one. If they appear to fulfill the basic criteria for a diagnosis of NPD, I then look to see what recognized subgroup of NPD—Exhibitionist, Malignant, or Closet—best fit the client. Each of these subgroups needs a somewhat different therapeutic approach.Punchline: I do not know of any trained mental health clinicians who are licensed to diagnose personality disorders (usually only psychologists and psychiatrists) who thinks that Vaknin is on the right track. In general, if they know of him at all, they dismiss him as a fraud. This situation is actually a shame because Vaknin is intelligent, just not educated. I would happily welcome him as a colleague if he went back to school and actually studied personality disorders.A2AElinor Greenberg, PhD, CGPIn private practice in NYC and the author of the book: Borderline, Narcissistic, and Schizoid Adaptations.www.elinorgreenberg.com

Child labor was limited by law. In 1883 most of my Grandmother’s classmates left school at the age of nine years to go and work in the factories. By my Mother’s time, the children would almost always finish the eighth grade ( 1920). By the 1950,s laws were clear to me as a teenager. If I worked before age 14 years, it was informal and only for a few hours since school came first. At 14, I had to be examined by the NYC Health Department before obtaining “working papers” and my hours were limited. At 16, I was legally allowed to quit school and work full time, but most students completed High School by 17 or 18.So, in the U.S., it was an evolution of law, not merely custom. Children can work at a very young age but without laws protecting them, both their safety and their education are at risk.

I moved to the UK from NYC in 1992, to marry my love. That same year, I turned 40.Now, first, I have to point out that my father was a very well respected doctor, who had a private practice for many years. He treated his staff well, and made house calls, and often saw people for free. When I got sick, I mostly asked his advice, or he treated me.However, I felt that, as an adult, I should find my own doctor in NYC. I had a small IT company, and an extremely good insurance agent, who got us inexpensive health insurance. I still had to pay the first $100, and there was an annual limit, but it was affordable.Unless — and here’s the catch — the insurance company disallowed certain procedures. I once had to pay $850 for treatment for severe pain in my ears, which ended up as earwax removal, because the tests imposed by the practice I went to were disallowed.My sister once cut her hand badly, and had to wait in the emergency room of the nearest hospital for six hours, bleeding and in pain. That was expensive.On holiday in the US, some years later, I broke my thumb skiing. Fortunately, I had very good travel insurance, because I would never have been able to pay the hospital bill, the anaesthetists bill and the surprise bill that turned up six weeks after the others, from some other doctor; I can’t remember the total, but I think it was over $10,000.Over here? I have a persistent eye problem, very painful, probably caused by getting measles when I was young (before the vaccine was developed). In the US, when I went to a doctor, he sneered at me and told me it was probably caused by a herpetic infection, and nothing could be done. Cost? After the deductible, about $250 in the late ‘80s. Here, after a number of examinations, I was referred to Moorfields Eye Hospital, one of the leading eye centres in the world, where they did a thorough exam, told me precisely what the underlying cause was (although they didn’t know about the measles; I only made the connection later) and gave me ointments. Cost? Nothing.I have never had to wait too long, and there is always a numbered queueing system. The staff are invariably friendly, professional and reassuring.In the city where my mother-in-law lives, she has had a number of tests, been picked up by paramedics after a collapse, seen by district health care professionals when she has had illnesses that are related to her dementia. Always professional, concerned and thorough. And free.So, yes. I find that the healthcare in the UK is better. It is in desperate need of proper funding, better organisation and better salaries and care for the dedicated people who work there, and who are losing their morale. That, however, is due to government stupidity, inability to manage, and the crazy desire to emulate the profit-driven US system.Sorry, I could go on for ages and pages about US healthcare, but I tell you: it’s not all that.